Investigator accuses city of improper Medicare, Medicaid billing

Relator says basic life support ambulance runs were wrongly coded

A federal lawsuit in U.S. District Court for the Northern District of Texas resulted in $2.769 million in settlements for plaintiffs United States of America, State of Texas and relator Douglas Moore. This came from plaintiffs’ claims that defendants city of Dallas, Texas, and Southwest General Services of Dallas, L.L.C., were engaging in fraud against the government, in addition to claims of retaliation after Moore was terminated from his position.

In 2009, Douglas Moore, an investigator for the Dallas City Auditor’s Office, became concerned that the city was defrauding the Medicare and Texas Medicaid programs by improperly billing for certain ambulance transport services. Moore advised other members of the auditor’s office of his findings.

In August 2009, dissatisfied with the city’s failure to address his concerns, Moore filed suit under the qui tam provisions of the federal False Claims Act and the Texas Medicaid Fraud Prevention Act.

Moore’s complaint alleged that Southwest General Services of Dallas, LLC, which performed ambulance-service billing, coded 100 percent of the city’s 911-dispatch ambulance transports at the Advanced Life Support (ALS) level, regardless of whether the patient’s medical condition justified the claim or if an ALS-level service was actually furnished.

As a result, it was asserted, many runs should have been coded and billed as basic life support (BLS), which is reimbursed at a lower rate by both Medicare and Medicaid. Accordingly, Moore alleged that the city received higher Medicare and Medicaid reimbursements than it was entitled to and was at all times aware of Southwest General Services of Dallas, LLC’s activities.

On Nov. 10, 2009, Moore received a “Fully Successful” performance review from the city. Despite this, Moore was terminated from his position with the city Dec. 2, 2009, two business days after the city was made aware of his lawsuit.

According to Dallas City Auditor Craig Kinton, Moore was terminated because his “services were no longer needed,” but it was contended that, days later, the city posted a job listing for Moore’s previous position. Following his termination, Moore amended his complaint to add allegations of retaliation.

On June 7, 2011, the city entered into a $2.47 million settlement. Under agreement terms, Moore was entitled to receive up to 30 percent of the recovery as his relator’s share. On Nov. 16, 2011, the city entered into a $299,000 settlement with Moore to resolve the allegations that the city retaliated against him after learning that he had filed his qui tam suit.

Type of action: Federal False Claims Act/qui tam action

Types of injuries: Fraud against U.S. Government; retaliation against relator for filing qui tam action

Name of case:United States of America, et al. ex rel. Moore v. City of Dallas, et al.

Court/Case no./Date: U.S. District Court, Northern District of Texas; 3:00-cv-1452; June 7, 2011, and Nov. 16, 2011